Area-level Racism and Oral Health: an Australian Nation-Wide Ecological Analysis

Objectives: Research consistently shows that racism is a powerful driver of population patterns of health, disease, and well-being. The extant studies on this topic are mainly based on individual-level measures of racial discrimination. How racism at broader conceptual levels affects health is still unclear.
The aim of this study is to investigate the association between area-level racism and oral health in Australian children.
Methods: Area-based racism was estimated using the 2007-2016 Scanlon Social Cohesion Surveys, and oral health we assessed with the 2012-2014 National Child Oral Health Survey (NCOHS). Individuals from both studies were aggregated in Statistical Areas Level 3 (SA3 – Australian Bureau of Statistics) based on their postcodes, and ecological analyses were conducted. Area-level racism was evaluated based on aggregated responses to items such as “Accepting immigrants from many different countries makes Australia stronger” and “Ethnic minorities in Australia should be given Australian government assistance.” SA3s were classified as high (above median) or low (at or below median) in their estimates of racism. Clinical and self-reported oral health indicators were the outcomes, namely DMFT Index (Decayed, Missing, Filled Teeth Index) and each of its components, and self-rated oral health.
Results: 23,643 children aged 5 to 15 years in the NCOHS were aggregated in 276 SA3s. Areas with high estimates of racism presented higher prevalence of poor oral health; this association persisted even after adjusting for area-level socioeconomic position (Index of Relative Socio-economic Advantage and Disadvantage) and remoteness (Accessibility and Remoteness Index of Australia). For instance, the adjusted prevalence of dental caries experience was 40.2% (95% Confidence Interval (95%CI 38.2-42.2)) within low racism areas and 46.1% (95%CI 44.1-48.1) in high racism areas.
Conclusions: We identified pervasive and consistent effects of area-level racism on oral health outcomes among Australian children. These results may inform wider strategies to address racism and its health impacts.